Optimized Stereo-Electroencephalography-Guided Three-Dimensional Radiofrequency Thermocoagulation for Hypothalamic Hamartomas-Related Epilepsy: A Single-Center Experience in 69 Patients

IF 4.8 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-06-07 DOI:10.1111/cns.70462

Yang Dai, Yihe Wang, Zesheng Li, Xiaotong Fan, Liankun Ren, Josemir W. Sander, Penghu Wei, Yongzhi Shan, Guoguang Zhao

{"title":"Optimized Stereo-Electroencephalography-Guided Three-Dimensional Radiofrequency Thermocoagulation for Hypothalamic Hamartomas-Related Epilepsy: A Single-Center Experience in 69 Patients","authors":"Yang Dai, Yihe Wang, Zesheng Li, Xiaotong Fan, Liankun Ren, Josemir W. Sander, Penghu Wei, Yongzhi Shan, Guoguang Zhao","doi":"10.1111/cns.70462","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The high risk of resection surgery for hypothalamic hamartoma (HH) epilepsy drives interest in minimally invasive treatment. Stereo-electroencephalography-guided three-dimensional radiofrequency thermocoagulation (SEEG-3D RFTC) offers an alternative option. We investigated this technology's efficacy, safety, and prognostic risk factors.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Patients with HH who underwent SEEG-3D RFTC were retrospectively analyzed. A high-density focal stereo-array electrode implantation was adopted. SEEG-3D RFTC was performed between two contiguous contacts of the same electrode or adjacent contacts of different electrodes. Outcomes were separately evaluated for clinical seizures, gelastic seizures (GS), and non-gelastic seizures (nGS). Kaplan–Meier survival analysis was used to assess treatment effectiveness. Risk factors were analyzed using log-rank tests and Cox regression analyses.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Sixty-nine patients were enrolled. The mean follow-up was 41.00 ± 18.19 months. Seizure freedom was obtained by 48/69 (69.57%) patients for clinical seizures, 50/62 (80.65%) patients for GS, and 41/54 (75.93%) patients for nGS. Surgical procedures were well tolerated. In this study, the proportion of patients experiencing long-term complications was 10.14%. The percentages of HH ablation (<i>p</i> = 0.003; hazard ratio 0.956, 95% confidence interval 0.928–0.985) and HH attachment ablation (<i>p</i> = 0.001; hazard ratio 0.931, 95% confidence interval 0.892–0.970) were significantly associated with seizure outcomes.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Optimized SEEG-3D RFTC is an effective and safe option for HH-related epilepsy and is especially suitable for use where laser interstitial thermal therapy is unavailable. Complete ablation of the HH and attachment site is essential for good outcomes.</p>\n </section>\n </div>","PeriodicalId":154,"journal":{"name":"CNS Neuroscience & Therapeutics","volume":"31 6","pages":""},"PeriodicalIF":4.8000,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cns.70462","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CNS Neuroscience & Therapeutics","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cns.70462","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The high risk of resection surgery for hypothalamic hamartoma (HH) epilepsy drives interest in minimally invasive treatment. Stereo-electroencephalography-guided three-dimensional radiofrequency thermocoagulation (SEEG-3D RFTC) offers an alternative option. We investigated this technology's efficacy, safety, and prognostic risk factors.

Methods

Patients with HH who underwent SEEG-3D RFTC were retrospectively analyzed. A high-density focal stereo-array electrode implantation was adopted. SEEG-3D RFTC was performed between two contiguous contacts of the same electrode or adjacent contacts of different electrodes. Outcomes were separately evaluated for clinical seizures, gelastic seizures (GS), and non-gelastic seizures (nGS). Kaplan–Meier survival analysis was used to assess treatment effectiveness. Risk factors were analyzed using log-rank tests and Cox regression analyses.

Results

Sixty-nine patients were enrolled. The mean follow-up was 41.00 ± 18.19 months. Seizure freedom was obtained by 48/69 (69.57%) patients for clinical seizures, 50/62 (80.65%) patients for GS, and 41/54 (75.93%) patients for nGS. Surgical procedures were well tolerated. In this study, the proportion of patients experiencing long-term complications was 10.14%. The percentages of HH ablation (p = 0.003; hazard ratio 0.956, 95% confidence interval 0.928–0.985) and HH attachment ablation (p = 0.001; hazard ratio 0.931, 95% confidence interval 0.892–0.970) were significantly associated with seizure outcomes.

Conclusions

Optimized SEEG-3D RFTC is an effective and safe option for HH-related epilepsy and is especially suitable for use where laser interstitial thermal therapy is unavailable. Complete ablation of the HH and attachment site is essential for good outcomes.

查看原文本刊更多论文

优化立体脑电图引导的三维射频热凝治疗下丘脑错构瘤相关癫痫：69例患者的单中心经验

背景下丘脑错构瘤（HH）癫痫切除手术的高风险引起了微创治疗的兴趣。立体脑电图引导的三维射频热凝（SEEG-3D RFTC）提供了另一种选择。我们调查了该技术的有效性、安全性和预后风险因素。方法对HH行SEEG-3D RFTC的患者进行回顾性分析。采用高密度聚焦立体阵列电极植入。SEEG-3D RFTC在同一电极的两个相邻触点或不同电极的相邻触点之间进行。分别评估临床癫痫发作、弹性癫痫发作（GS）和非弹性癫痫发作（nGS）的结果。Kaplan-Meier生存分析评估治疗效果。危险因素分析采用log-rank检验和Cox回归分析。结果69例患者入组。平均随访41.00±18.19个月。临床发作患者中48/69（69.57%）、GS患者中50/62（80.65%）、nGS患者中41/54（75.93%）获得癫痫发作自由。外科手术的耐受性良好。本研究中出现长期并发症的患者比例为10.14%。HH消融的百分比(p = 0.003；风险比0.956,95%可信区间0.928-0.985)和HH附着消融(p = 0.001；风险比0.931（95%可信区间0.892-0.970）与癫痫发作结局显著相关。结论优化后的SEEG-3D RFTC治疗hh相关性癫痫是一种安全有效的选择，尤其适用于无法进行激光间质热治疗的患者。完全消融HH和附着部位是获得良好结果的必要条件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.